Inbound Outbound Queue Associate – Must reside in EST

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Shift: Monday-Friday, 8:00AM-5:00PM EST Position Summary Supports comprehensive coordination of medical services including intake, screening and referrals to Aetna Medical Services Programs. Responsibilities - Promotes/supports quality effectiveness of Healthcare Services. Performs intake of calls from members or providers regarding services via telephone, fax, EDI. - Utilizes eTUMS and other Aetna system to build, research and enter member information. - Screens requests for appropriate referral to medical services staff. Approve services that do not require a medical review in accordance with the benefit plan. - Performs non-medical research including eligibility verification, COB, and benefits verification. - Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements. - Promotes communication, both internally and externally to enhance effectiveness of medical management services (e.g., claim administrators, Plan - Sponsors, and third party payers as well as member, family, and health care team members respectively). - Protects the confidentiality of member information and adheres to company policies regarding confidentiality - Communicate with Aetna Case Managers, when processing transactions for members active in this Program - Supports the administration of the precertification process in compliance with various laws and regulations, URAQ and/or NCQA standards, where applicable, while adhering to company policy and procedures. - Places outbound c...